Bottom Line:
The standardized incidence ratios (SIRs; a measure of risk) relative to the general population were evaluated and compared with published rates.Patients with RA continued to show an increased risk of lymphoma and lung cancer compared with the general population.Overall, SIR estimates for colorectal and breast cancers continued to show a decrease in risk, whereas cervical cancer, prostate cancer and melanoma appeared to show no consistent trend in risk among patients with RA compared with the general population.

Introduction: Patients with rheumatoid arthritis (RA) are at an increased risk of malignancies compared with the general population. This has raised concerns regarding these patients, particularly with the widespread use of immunomodulating therapies, including biologic disease-modifying antirheumatic drugs (DMARDs). We performed a systematic literature review and analysis to quantify the incidence of malignancies in patients with RA and the general population to update previously published data.

Methods: A literature search was conducted that was consistent with and similar to that in a meta-analysis published in 2008. MEDLINE, BIOSIS Previews, Embase, Derwent Drug File and SciSearch databases were searched using specified search terms. Predefined inclusion criteria identified the relevant observational studies published between 2008 and 2014 that provided estimates of relative risk of malignancy in patients with RA compared with the general population. Risk data on overall malignancy and site-specific malignancies (lymphoma, melanoma and lung, colorectal, breast, cervical and prostate cancer) were extracted. The standardized incidence ratios (SIRs; a measure of risk) relative to the general population were evaluated and compared with published rates.

Results: A total of nine publications met the inclusion criteria. Seven of these reported SIRs for overall malignancy; eight for lymphoma, melanoma, and lung, colorectal and breast cancer; seven for prostate cancer; and four for cervical cancer. Compared with those in the general population, the SIR estimates for patients with RA suggest a modest increased risk in overall malignancy, as previously observed. Patients with RA continued to show an increased risk of lymphoma and lung cancer compared with the general population. Overall, SIR estimates for colorectal and breast cancers continued to show a decrease in risk, whereas cervical cancer, prostate cancer and melanoma appeared to show no consistent trend in risk among patients with RA compared with the general population.

Conclusions: The additional data evaluated here are consistent with previously reported data. Patients with RA are at an increased risk of lung and lymphoma malignancies compared with the general population. Quantifying differences in malignancy rates between non-biologic and biologic DMARD-treated patients with RA may further highlight which malignancies may be related to treatment rather than to the underlying disease.

Fig6: Relative risk of lung cancer in patients with rheumatoid arthritis (RA) compared with the general population. CI, confidence interval; DMARD, disease-modifying antirheumatic drug; MTX, methotrexate; n, number of malignancies; N, population size; SIR, standardized incidence ratio; TNF, tumor necrosis factor. *SIRs by sex are included in total pooled SIR only if overall SIR was not available. †Reported as odds ratio

Mentions:
In eight studies, authors reported that patients with RA had an increased risk of lung cancer compared with the general population [10, 12–17, 19]. The SIRs (95 % CI) for lung cancer ranged from 1.36 (1.34–1.38) to 2.9 (1.6–4.8) (Fig. 6) [10, 12–17, 19–22, 24–28, 32, 36–38]. The total pooled SIR (95 % CI) for the studies reviewed here and by Smitten et al. [6] was 1.64 (1.51–1.79) for lung cancer. The risk of lung cancer in patients with RA compared with the general population in the contemporary study is consistent with what was previously observed (1.63 [1.43–1.87]) [6].Fig. 6

Fig6: Relative risk of lung cancer in patients with rheumatoid arthritis (RA) compared with the general population. CI, confidence interval; DMARD, disease-modifying antirheumatic drug; MTX, methotrexate; n, number of malignancies; N, population size; SIR, standardized incidence ratio; TNF, tumor necrosis factor. *SIRs by sex are included in total pooled SIR only if overall SIR was not available. †Reported as odds ratio

Mentions:
In eight studies, authors reported that patients with RA had an increased risk of lung cancer compared with the general population [10, 12–17, 19]. The SIRs (95 % CI) for lung cancer ranged from 1.36 (1.34–1.38) to 2.9 (1.6–4.8) (Fig. 6) [10, 12–17, 19–22, 24–28, 32, 36–38]. The total pooled SIR (95 % CI) for the studies reviewed here and by Smitten et al. [6] was 1.64 (1.51–1.79) for lung cancer. The risk of lung cancer in patients with RA compared with the general population in the contemporary study is consistent with what was previously observed (1.63 [1.43–1.87]) [6].Fig. 6

Bottom Line:
The standardized incidence ratios (SIRs; a measure of risk) relative to the general population were evaluated and compared with published rates.Patients with RA continued to show an increased risk of lymphoma and lung cancer compared with the general population.Overall, SIR estimates for colorectal and breast cancers continued to show a decrease in risk, whereas cervical cancer, prostate cancer and melanoma appeared to show no consistent trend in risk among patients with RA compared with the general population.

Introduction: Patients with rheumatoid arthritis (RA) are at an increased risk of malignancies compared with the general population. This has raised concerns regarding these patients, particularly with the widespread use of immunomodulating therapies, including biologic disease-modifying antirheumatic drugs (DMARDs). We performed a systematic literature review and analysis to quantify the incidence of malignancies in patients with RA and the general population to update previously published data.

Methods: A literature search was conducted that was consistent with and similar to that in a meta-analysis published in 2008. MEDLINE, BIOSIS Previews, Embase, Derwent Drug File and SciSearch databases were searched using specified search terms. Predefined inclusion criteria identified the relevant observational studies published between 2008 and 2014 that provided estimates of relative risk of malignancy in patients with RA compared with the general population. Risk data on overall malignancy and site-specific malignancies (lymphoma, melanoma and lung, colorectal, breast, cervical and prostate cancer) were extracted. The standardized incidence ratios (SIRs; a measure of risk) relative to the general population were evaluated and compared with published rates.

Results: A total of nine publications met the inclusion criteria. Seven of these reported SIRs for overall malignancy; eight for lymphoma, melanoma, and lung, colorectal and breast cancer; seven for prostate cancer; and four for cervical cancer. Compared with those in the general population, the SIR estimates for patients with RA suggest a modest increased risk in overall malignancy, as previously observed. Patients with RA continued to show an increased risk of lymphoma and lung cancer compared with the general population. Overall, SIR estimates for colorectal and breast cancers continued to show a decrease in risk, whereas cervical cancer, prostate cancer and melanoma appeared to show no consistent trend in risk among patients with RA compared with the general population.

Conclusions: The additional data evaluated here are consistent with previously reported data. Patients with RA are at an increased risk of lung and lymphoma malignancies compared with the general population. Quantifying differences in malignancy rates between non-biologic and biologic DMARD-treated patients with RA may further highlight which malignancies may be related to treatment rather than to the underlying disease.